Chronic Wound and

Dressing Material

원광대병원 성형외과

나 영 천

염증이 어느 정도 control이 되어

상처가 벌어져 있는 환자가 내원하였다.

1. 열려져 있는 상처에는 어떠한 dressing이

가장 좋은가!

2. 요즘 새로 나오는 많은 dressing material 등은

어떤 상처인 경우에 각각 사용하면 더 좋은가!

3. 수술을 할 수 있을 정도의 상처의 조건은

어떤 것들이 있나!

Case

By

Case

Chronic wound

Definition 1. It has not healed in 4 weeks 2. Wounds that have not shown a 20-40% reduction in area after 2-4 weeks of optimal therapy 3. Standard surgical textbooks: have not healed in 3 months

Culture!

Deep Tissue Biopsy

Debridement 후 Swab Culture

Saline Wet gauze frequent dressing

• Debridement 후 • Hydro gel 적용

• Mechanical frequent

• Hydre gel + foam

Callus관리

Surgical debridement

Hydro gel + foam or hydrocolloid

Hydrocolloid or Hydro gel + foam

Bullae aspiration and Potadine or foam

Hydrocolloid

Surgical debridement Aquacel Ag

Incision & drainage

Frequent saline dressing

NPWT 적용 60일 후

Frequent saline dressing

Surgical debridement

NPWT 적용

STSG

Frequent dressing

STSG

Preparation of wound

1. Free of Pus : 105 organisms/grams -> a few culture

2. Healthy, pink to beefy red appearance 3. Ideal wound pH of 7.4 or higher 4. Epithelial migration at the edge of

the granulating surface

5. Free of necrotic tissue

Surgical debridement

NPWT 적용

STSG

Advancement flap

Reverse sural flap

감 사 합 니 다